Inpatient Rotations Research Articles

S2189 Improving Internal Medicine Residents' Education in the Gastroenterology/Hepatology Inpatient Consult Rotation With the Use of a Clinical Pocket Handbook

S2189 Improving Internal Medicine Residents' Education in the Gastroenterology/Hepatology Inpatient Consult Rotation With the Use of a Clinical Pocket Handbook

The Educational Experience Improvement Collective for Inpatient Medicine Healthcare Professional Trainees at a University-Affiliated Veterans Affairs Medical Center

Background: Rotation evaluations reflect the resident-perceived value of clinical experiences in graduate medical education. In this study, we sought to improve the quality of education for internal medicine residents during their inpatient medicine rotation. Methods: Program stakeholders critically appraised a core medicine rotation at a university-affiliated U.S. Veterans Affairs Medical Center utilizing end-of-rotation evaluations by residents. Thematic analysis identified three areas for improvement: culture, communication, and workload. Solutions were developed to address each theme: (1) site-specific orientation was provided to new trainees, (2) real-time notification of admissions occurred via secure messaging platform, and (3) an assistive rounding tool was integrated into the electronic medical record. Outcome measures of education were obtained via end-of-rotation evaluations by residents. Results: This study included 198 pre-intervention and 58 post-intervention evaluations by trainees from October 2022 through December 2023. Using a 5-point Likert scale, the quality of education improved from good to very good (3.26 to 4.02, +15%, p < 0.001) over the course of one year. All four subcategories also improved: diversity/quality of pathology (0.33; +7%), supervision (0.50; +10%), workload (0.42; +8%), and learning value (0.51; +10%). When the five categories are compared immediately pre-intervention (fourth quarter of 2022-2023 academic year) to full post-intervention (second quarter of 2023-2024 academic year) using a paired t-test, the change was statistically significant (p = 0.007). Conclusions: Significant educational enhancements were achieved over time for a core rotation in a residency program using solutions developed from interconnected themes found in learner evaluations.

Examining Delineated Competencies within Blended Hospital/Health System Pharmacy and General Medicine Advanced Pharmacy Practice Experiences.

In the United States, Doctor of Pharmacy (PharmD) programs are required to provide advanced pharmacy practice experiences (APPEs) in the core inpatient rotation areas of hospital/health system pharmacy and inpatient general medicine patient care. Colleges and Schools of Pharmacy (C/SOPs) nationwide are increasingly utilizing blended or longitudinal APPE models to offer experiential opportunities; however, there is a gap in the literature to support programs with delineating rotation-specific competencies when integrating two or more rotations together. Utilizing a survey instrument, PharmD students at two C/SOPs reported their onsite inpatient rotation sub-competency activities achieved within the four competency areas of Hospital/Health Pharmacy Systems, Medication Safety and Quality, Clinical Applications, and Professional Practice, which are listed in Appendix C of the 2016 Accreditation Council for Pharmacy Education Standards Guidance Document. Unpaired two-sample t-tests were performed to compare proportions of sub-competency activity occurrence in the two rotation settings. In total, 168 students reported inpatient activities related to the four competency areas, with 95-100% reporting their involvement in one or more sub-competency opportunities within each area. Of the 26 sub-competencies compared, 73% significantly facilitated the development of competency to a greater extent for one APPE inpatient rotation type over the other (p < 0.05). The findings can be utilized by C/SOPs to support the delineation of rotation-specific competencies when blending inpatient experiential opportunities.

How Many Is Too Many? Using Cognitive Load Theory to Determine the Maximum Safe Number of Inpatient Consultations for Trainees.

Cognitive load, specifically extraneous load (EL) reflective of distractions, may provide evidence of a lack of focus, potentially making additional work unsafe. The assessment of trainees performing inpatient consultations provides a helpful model for examining this question. The goal of this study was to provide useful information to clinical and educational leaders to optimize inpatient consultation services and rotations and mitigate potential patient safety risk. In 2019, using the Consult Cognitive Load instrument, the authors obtained EL data from inpatient consultations performed by internal medicine fellows and psychiatry residents across 5 University of California hospitals. In 2023, the authors constructed a Wright map to compare the participants' EL data with the number of prior initial consultations performed during the shift. Of 326 trainees contacted, 139 (43%) completed the EL survey items. The Wright map shows that trainees were estimated to agree that interruptions were already distracting at the first consultation of the shift. After 4 consultations, trainees were estimated to strongly agree that interruptions were distracting and to agree that emotions, extraneous information, and technology were distracting. The authors propose a quantitative, empirically driven, mean safety limit of 4 new inpatient consultations per shift for trainees to avoid cognitive overload, thereby potentially supporting patient safety. Clinical and educational leaders can adjust this limit to fit the unique needs of their practice setting. A similar approach using cognitive load and item response theory could be used to conduct patient safety research in other domains.

Integrating Palliative Medicine into Medical Education: Creating a More Compassionate Generation of Physicians

How should Palliative Medicine competencies be taught to medical students? In the United States and other countries, there is a consensus that teaching Palliative Medicine competencies to medical students is essential. Health agencies have also identified teaching Palliative Medicine competencies as crucial. According to Sanchez-Reilly and Ross, medical students reported that they feel better prepared to care for the elderly, patients with severe illness, and dying patients after completing formal training. The authors hypothesized that a one-week rotation with Palliative Medicine during the Medicine Clerkship would improve the medical students’ skills to care for these populations of patients. The one-week inpatient rotation was designed to equip all fifty medical students at Mayo Medical School with a knowledge base of Palliative Care, communication skills, care for elderly frail and dying patients, and basic pain management for patients with severe illness. Each of the fifty students rotated with a Palliative Care consulting team with patient interaction, lectures, online teaching, and interdisciplinary team activities. Hands-on learning proved more effective than using just the classroom teaching classical model, with 70% of students responding positively to the hands-on approach. Learning how to apply Palliative Care skills while visiting patients with complex diseases, showed to be better received as an education module. Out of the fifty medical students surveyed, thirty-five responded (70%), and all responses were positive. This method of teaching could be expanded to teach other advanced hospice and palliative care skills.

Design, Implementation, and Evaluation of a Logbook for Clinical Education of Undergraduate Physiotherapy Students

Introduction: Clinical performance without documentation, assessment, and feedback may lead to an inefficient internship in the field. Logbooks are recommended to assess physiotherapy (PT) students’ clinical practice in the curriculum, therefore, this study aims to design, implement, and evaluate a logbook for undergraduate PT students. Materials and Methods: The present study includes three phases. In the first phase, a logbook was designed based on the existing evidence, undergraduate PT program curriculum, and opinions of clinical instructors of the relevant internships. After that, it was adjusted based on the topics of clinical rotations. In the implementation phase, students completed these logbooks during neurology, musculoskeletal inpatient, outpatient, and cardiovascular inpatient rotations. In the third phase, a 29-item questionnaire was used to assess the students’ and instructors’ perspectives on the logbook. Results: The designed logbook for undergraduate PT students consisted of two major sections, assessment of students’ clinical competencies and documentation of clinical experience. Sixtynine students and 12 clinical instructors completed the questionnaires. Approximately 49% of the students and 87% of the instructors felt that the logbook’s quality was satisfactory. Nearly 53% of the students and over 90% of the instructors consider the use of the logbook and its content essential. Conclusion: A logbook was developed as a workplace-based assessment (WBA) method. It was designed to cover different internships, including PT in musculoskeletal, cardiovascular, and neurological conditions in outpatient or inpatient settings. Both students and instructors agreed on using the designed logbook to assess the student’s clinical performance.

Frontline assessors’ opinions about grading committees in a medicine clerkship

BackgroundCollective decision-making by grading committees has been proposed as a strategy to improve the fairness and consistency of grading and summative assessment compared to individual evaluations. In the 2020–2021 academic year, Washington University School of Medicine in St. Louis (WUSM) instituted grading committees in the assessment of third-year medical students on core clerkships, including the Internal Medicine clerkship. We explored how frontline assessors perceive the role of grading committees in the Internal Medicine core clerkship at WUSM and sought to identify challenges that could be addressed in assessor development initiatives.MethodsWe conducted four semi-structured focus group interviews with resident (n = 6) and faculty (n = 17) volunteers from inpatient and outpatient Internal Medicine clerkship rotations. Transcripts were analyzed using thematic analysis.ResultsParticipants felt that the transition to a grading committee had benefits and drawbacks for both assessors and students. Grading committees were thought to improve grading fairness and reduce pressure on assessors. However, some participants perceived a loss of responsibility in students’ grading. Furthermore, assessors recognized persistent challenges in communicating students’ performance via assessment forms and misunderstandings about the new grading process. Interviewees identified a need for more training in formal assessment; however, there was no universally preferred training modality.ConclusionsFrontline assessors view the switch from individual graders to a grading committee as beneficial due to a perceived reduction of bias and improvement in grading fairness; however, they report ongoing challenges in the utilization of assessment tools and incomplete understanding of the grading and assessment process.

Irradiate the knowledge gap: Empowering residents for blood product selection at Albany Medical Center.

e23236 Background: Transfusion-associated graft versus host disease (ta-GvHD) poses risks for immunocompromised patients. Indications for irradiated blood products include hematological malignancies and bone marrow transplant cases. In instances of severe acute pancytopenia, the initial contact at the emergency room (ER) is typically a nurse, followed by the ER physician. Patients referred from the local private practice, New York Oncology and Hematology (NYOH) office to our local hospital, Albany Medical Center (AMC), often bring comprehensive paper charts, but those coming directly from home frequently lack necessary documents, relying on the medical teams' expertise to ensure appropriate blood product selection. We aim to improve understanding of transfusion products and their indications. Methods: An initial pre-survey questionnaire was sent to internal medicine residents. Of the 33 responses received, 87.9% were aware of the need for irradiated blood products in hematological malignancies, 66.6% knew it was not required for solid tumors, and only 57.6% knew about the need for CAR-T patients. Additionally, only 15.2% knew where to find information on selecting irradiated blood products at AMC. The analysis highlighted a significant knowledge gap in transfusing irradiated blood products for hematological and oncological malignancies. In response, a user-friendly educational resource was created and displayed in residents' conference rooms during inpatient rotations, with plans for intermittent educational sessions over the next months. A comprehensive educational initiative addressed this aspect of patient care within the inpatient service, distributing detailed materials and discussions with the internal medicine residents at AMC. The focus was on emphasizing the critical requirement for irradiated blood products in specific clinical scenarios, particularly when managing patients with hematological malignancies and other conditions where irradiated blood is medically indicated. Results: A follow-up survey, conducted four months after distributing educational material on medicine floors, included responses from 27 internal medicine residents. Notably, 100% and 88.9% were knowledgeable about the necessity of irradiated blood products in hematological malignancies and bone marrow transplant recipients, respectively. Additionally, 24 out of 27 residents were aware that irradiated products are unnecessary for solid tumor malignancies in adult patients. All residents knew where to find information on blood product selection at AMC, and 92.6% found the education material helpful. Conclusions: Improved knowledge among residents underscores our commitment to patient care. We aim to extend education on irradiated blood product necessity beyond our residency program. Our long-term vision is to broaden this critical knowledge across the healthcare community at AMC.

Impact of Ambulatory Blocks on Pulmonary Critical Care Fellow Outpatient Training Experience.

The Accreditation Council for Graduate Medical Education requires Pulmonary and Critical Care Medicine (PCCM) fellows spend a minimum of 7% of their time in the outpatient setting over 3 years of training. In a multi-institutional survey, only 47% of PCCM fellows rated their ambulatory training as adequate. Internal medicine residencies previously adopted the "x + y" scheduling model, which separates inpatient ("x") and outpatient ("y") rotations to provide focused ambulatory experiences, to address similar concerns. To observe the effects of dedicated ambulatory blocks at a single academic PCCM fellowship on fellow exposure to outpatient pulmonary medicine, and on fellow and faculty perceptions of education. In the 2021-2022 academic year, PCCM fellows of all class years in a single academic fellowship program in the northeast United States rotated through four 2-week ambulatory blocks that included longitudinal clinics, themed subspecialty clinics, and a dedicated educational half-day for small group learning. Before the intervention, fellow ambulatory clinics were scheduled longitudinally one-half day per week during inpatient and research blocks. Both fellows and faculty were surveyed before and after the intervention; fellows were also interviewed via focus groups at the conclusion of the intervention. The degree of subspecialty clinic exposure was compared before and after intervention. There was an increase in the quantity and variety of pulmonary subspecialty clinics per fellow when compared with preintervention years (P < 0.01). After intervention, we observed increased fellow satisfaction with ambulatory education, perceived preparedness for independent practice, and satisfaction with subspecialty clinic exposure (P < 0.05). Faculty satisfaction with fellow ambulatory pulmonary education also increased (P < 0.05). Thematic analysis from focus groups highlighted focused topical learning, exposure to the breadth of pulmonary medicine, career development, interaction with engaged faculty experts, and enhanced interprofessional competence. The ambulatory block structure provides a potential model to expand PCCM fellow outpatient pulmonary training through increased exposure to ambulatory pulmonology and dedicated ambulatory teaching. Important features of the ambulatory block structure include separation of outpatient clinics from competing responsibilities, expansion of fellow pulmonary exposure, opportunities for deliberate practice, and faculty engagement in fellow education.

Creating and confirming observable professional activities (OPAs): A pilot study evaluating the feasibility of OPAs on a residency inpatient spinal cord injury rotation.

Creating and confirming observable professional activities (OPAs): A pilot study evaluating the feasibility of OPAs on a residency inpatient spinal cord injury rotation.

Inpatient Rotation from High-Dose Oral Methadone to Sublingual Buprenorphine in a Patient with Chronic Pain

Inpatient Rotation from High-Dose Oral Methadone to Sublingual Buprenorphine in a Patient with Chronic Pain

The Impact of Changing From a 6+2 to a 3+1 Residency Block Schedule on Patient Access and Other Outcomes.

Background The "X+Y" residency scheduling model includes "X" weeks of uninterrupted inpatient or subspecialty rotations, followed by "Y" week(s) of uninterrupted outpatient rotations. The optimal ratio of X to Y is unclear. Objective Determine the impact of moving from a 6+2 to a 3+1 schedule on patient access to care, perceived quality of care, and resident/faculty satisfaction. Methods Our residency program switched from a 6+2 to a 3+1 scheduling model in July 2018. We measured access to care before and after the change using the "third next available" (TNA) metric. In June 2019, we administered a voluntary, anonymous, 20-item survey to residents, staff, and faculty who worked in resident clinic in both the 6+2 and 3+1 years. Results Patient access to appointments with their resident physician, as measured by TNA, improved significantly after the schedule change (mean 34.1 days in 6+2, mean 26.5 days in 3+1, P<.0001). Fifteen of 17 (88%) eligible residents and 13 of 24 (54%) faculty/staff filled out the voluntary anonymous survey. Surveyed residents and faculty/staff had concordant perception that the schedule change led to improvement in patient continuity, quality of care, and ability of residents to follow up on diagnostic tests and have regular interaction with clinic attendings. However, residents did not report a change in satisfaction with continuity clinic. Conclusions Changing from a 6+2 to a 3+1 schedule was associated with improvement in patient access to care. Residents and faculty/staff perceived that this schedule change improved several aspects of patient care.

CRISP: An Inpatient Pediatric Curriculum for Family Medicine Residents Using Clinical Reasoning and Illness Scripts.

Clinical reasoning enables safe patient care and is an important competency in medical education but can be challenging to teach. Illness scripts facilitate clinical reasoning but have not been used to create pediatric curricula. We created CRISP (Clinical Reasoning with Illness Scripts in Pediatrics), a curriculum comprising four 1-hour learning sessions that deliberately incorporated clinical reasoning concepts and illness scripts to organize how four common chief complaints were taught to family medicine residents on inpatient pediatric rotations. We performed a multisite curriculum evaluation project over 6 months with family medicine residents at four institutions to assess whether the use of clinical reasoning concepts to structure CRISP was feasible and acceptable for learners and instructors and whether the use of illness scripts increased knowledge of four common pediatric chief complaints. For all learning sessions, family medicine residents and pediatric hospitalists agreed that CRISP's format was preferable to traditional didactic lectures. Pre-/posttest scores showed statistically significant increases in family medicine resident knowledge (respiratory distress [n = 42]: pretest, 72%, posttest, 92%; abdominal pain [n = 44]: pretest, 82%, posttest, 96%; acute febrile limp [n = 44]: pretest, 68%, posttest, 81%; well-appearing febrile infant [n = 42]: pretest, 58%, posttest, 73%; ps < .05). By using clinical reasoning concepts and illness script comparison to structure a pediatric curriculum, CRISP represents a novel instructional approach that can be used by pediatric hospitalists to increase family medicine resident knowledge about diagnoses associated with common pediatric chief complaints.

Development of a brief inpatient curriculum to enhance trainee skills in assessment and treatment of adolescents with substance use and co-occurring mental health problems

Background Adolescence is a critical period for substance use intervention, yet few youth receive evidence-based treatment for both co-occurring substance use and mental health problems. Gaps in professional training limit adequate assessment and treatment of substance use problems among youth receiving psychiatric treatment. Methods We developed a two-session curriculum, integrated into a child/adolescent psychiatry inpatient rotation, to improve knowledge and skills in evidence-based practices for screening, brief intervention, psychoeducation, and care coordination, among multidisciplinary mental health clinicians. A pre/post survey evaluated perceived helpfulness, confidence in clinical skills, and intentions to engage in evidence-based practices. Results Trainees perceived the content as helpful and reported significant increases in confidence and intention to engage in the targeted evidence-based practices. Conclusions Implementation of a brief, focused, skills-based curriculum in clinical settings can effectively introduce trainees to core concepts not currently adequately covered in existing curricula.

Diversity, equity, and inclusion (DEI) in medical education: DEI at the bedside

BackgroundThe ability to recognize and address bias is an important communication skill not typically addressed during training. We describe the design of an educational curriculum that aims to identify and change behavior related to diversity, equity, and inclusion (DEI). “DEI at the Bedside” uses the existing infrastructure of bedside teaching and provides a tool to normalize DEI discussions and develop skills to address bias during a neurology inpatient rotation. MethodsAs part of traditional clinical rounds, team members on an inpatient service shared experiences with DEI topics, including bias. The team developed potential responses should they encounter a similar situation in the future. We report the results of our needs assessment and curriculum development to evaluate the feasibility of incorporating a DEI educational curriculum in the neurology inpatient setting. ResultsForty-two DEI experiences were recorded. Medical students were the most frequent discussants (44%). Direction of bias occurred between healthcare team members (33%), against patients (31%), and patients against healthcare team members (28%). Experiences ranged from microaggressions to explicit comments of racism, sexism, and homophobia. ConclusionsBased on needs assessment data, we developed a DEI educational curriculum for the inpatient neurology setting aimed to improve knowledge and skills related to DEI topics as well as to normalize conversation of DEI in the clinical setting. Additional study will demonstrate whether this initiative translates into measurable and sustained improvement in knowledge of how bias and disparity show up in the clinical setting and behavioral intent to discuss and address them.

Internal Medicine Residents' Perceptions of Their Continuity Clinic Training.

Internal Medicine (IM) residents have reported dissatisfaction with continuity clinic (CC) training, which may contribute to the increasing shortage of primary care physicians. Studies show balancing inpatient and outpatient duties as a driver of dissatisfaction, but few studies have compared CC with inpatient (IP) training, following transition to an X + Y model, or assessed the impact of show rates, continuity, and telemedicine use on resident perceptions. The aim of this study was to adapt a validated survey to compare residents' perceptions of their CC with their inpatient medicine training and examine the impact of objective clinic measures on training. This quantitative cross-sectional study included a survey that was sent to 152 residents at an academic IM program in May-June 2021. Clinic measures such as show versus no-show rates, continuity with the residents' own patients, and visit modality were obtained through the electronic health records at Veterans Affairs and non-Veterans Affairs CCs. The survey response rate was 78% (118/152). Residents were more satisfied with inpatient general medicine rotations than their CC experience (4.5 vs 3.3 on a 5-point scale, P < 0.001). Residents were more likely to pursue a profession in inpatient IM than in primary care (3.7 vs 2.3, P < 0.001). No correlation was found between higher show rates, continuity with patients, or proportion of visits conducted through telemedicine and resident satisfaction with CC. This study aligns with previous findings of IM resident dissatisfaction with CC training while adding a side-by-side comparison to inpatient training and including objective CC data. We identified new areas for improvement of CC training, including residents' medical knowledge through review of quality metrics, making CC representative of real-world practice, and mentorship from faculty.

Resident Burnout, Wellness, Professional Development, and Engagement Before and After New Training Schedule Implementation

Burnout is a work-related syndrome of depersonalization (DP), emotional exhaustion (EE), and low personal achievement (PA) that is prevalent among internal medicine resident trainees. Prior interventions have had modest effects on resident burnout. The association of a new 4 + 4 block schedule (4 inpatient weeks plus 4 outpatient weeks) with resident burnout has not previously been evaluated. To evaluate the association of a 4 + 4 block schedule, compared with a 4 + 1 schedule, with burnout, wellness, and self-reported professional engagement and clinical preparedness among resident physicians. This nonrandomized preintervention and postintervention survey study was conducted in a single academic-based internal medicine residency program from June 2019 to June 2021. The study included residents in the categorical, hospitalist, and primary care tracks in postgraduate years 1 and 2 (PGY1 and PGY2). Data analysis was conducted from October to December 2022. In the 4 + 4 structure, resident schedules alternated between 4-week inpatient call-based rotations and 4-week ambulatory non-call-based rotations. The primary outcome was burnout, assessed using the Maslach Burnout Inventory subcategories of EE (range, 0-54), DP (range, 0-30), and PA (range, 0-48), adjusted for sex and PGY. Secondary outcomes included In-Training Examination (ITE) scores and a questionnaire on professional, educational, and health outcomes. Multivariable logistic regression was used to assess the primary outcome, 1-way analysis of variance was used to compare ITE percentiles, and a Bonferroni-adjusted Kruskal Wallis test was used for the remaining secondary outcomes. The findings were reexamined with several sensitivity analyses, and Cohen's D was used to estimate standardized mean differences (SMDs). Of the 313 eligible residents, 216 completed the surveys. A total of 107 respondents (49.5%) were women and 109 (50.5%) were men; 119 (55.1%) were PGY1 residents. The survey response rates were 78.0% (85 of 109) in the preintervention cohort and 60.6% (63 of 104) and 68.0% (68 of 100) in the 2 postintervention cohorts. The PGY1 residents had higher response rates than the PGY2 residents (119 of 152 [78.2%] vs 97 of 161 [60.2%]; P < .001). Adjusted EE scores (mean difference [MD], -6.78 [95% CI, -9.24 to -4.32]) and adjusted DP scores (MD, -3.81 [95% CI, -5.29 to -2.34]) were lower in the combined postintervention cohort. The change in PA scores was not statistically significant (MD, 1.4 [95% CI, -0.49 to 3.29]). Of the 15 items exploring professional, educational, and health outcomes, a large positive association was observed for 11 items (SMDs >1.0). No statistically significant change in ITE percentile ranks was noted. In this survey study of internal medicine resident physicians, a positive association was observed between a 4 + 4 block training schedule and internal medicine resident burnout scores and improved self-reported professional, educational, and health outcomes. These results suggest that specific 4 + 4 block combinations may better improve resident burnout than a 4 + 1 combination used previously.

An Embedded Curriculum to Teach Critical Incident Debriefing to Internal Medicine Residents.

Background Internal medicine residents frequently experience distressing clinical events; critical event debriefing is one tool to help mitigate their effects. Objective To evaluate the effectiveness of a 1-hour workshop teaching residents a novel, efficient approach to leading a team debrief after emotionally charged clinical events. Methods An internal needs assessment identified time and confidence as debriefing barriers. In response, we created the STREAM (Structured, Timely, Reflection, tEAM-based) framework, a 15-minute structured approach to leading a debrief. Senior residents participated in a 1-hour workshop on the first day of an inpatient medicine rotation to learn the STREAM framework. To evaluate learning outcomes, participants completed the same survey immediately before and after the session, and at the end of their 4-week rotation. Senior residents at another site who did not complete the workshop also evaluated their comfort leading debriefs. Results Fifty out of 65 senior residents (77%) participated in the workshop. After the workshop, participants felt more prepared to lead debriefs, learned a structured format for debriefing, and felt they had enough time to lead debriefs. Thirty-four of 50 (68%) workshop participants and 20 of 41 (49%) comparison residents completed the end-of-rotation survey. Senior residents who participated in the workshop were more likely than nonparticipants to report feeling prepared to lead debriefs. Conclusions A brief workshop is an effective method for teaching a framework for leading a team debrief.

Exploring gender and thematic differences in qualitative assessments of internal medicine resident performance

IntroductionEvidence suggests gender disparities in medical education assessment, including differences in ratings of competency and narrative comments provided in resident performance assessments. This study explores how gender manifests within the content of qualitative assessments (i.e., narrative comments or performance feedback) of resident performance.MethodsQualitative content analysis was used to explore gender-based differences in narrative comments included in faculty assessments of resident performance during inpatient medicine rotations at six Internal Medicine residency programs, 2016–2017. A blinded, multi-analyst approach was employed to identify themes across comments. Patterns in themes with resident gender and post-graduate year (PGY) were explored, focusing on PGY2 and PGY3 when residents are serving in the team leader role.ResultsData included 3,383 evaluations with narrative comments of 385 men (55.2%) and 313 women residents (44.8%). There were thematic differences in narrative comments received by men and women residents and how these themes manifested within comments changed with training time. Compared to men, comments about women had a persistent relationship-orientation and emphasized confidence over training including as interns and in PGY2 and PGY3, when serving as team leader. The relationship-orientation was characterized not only by the residents’ communal attributes but also their interpersonal and communication skills, including efforts supporting others and establishing the tone for the team. Comments about women residents often highlighted confidence, including recommendations around behaviors that convey confidence in decision-making and team leadership.DiscussionThere were gender-based thematic differences in qualitative assessments. Comments about women resident team leaders highlight relationship building skills and urge confidence and actions that convey confidence as team leader. Persistent attention to communal skills suggests gendered expectations for women resident team leaders and a lost opportunity for well-rounded feedback to the disadvantage of women residents. These findings may inform interventions to promote equitable assessment, such as providing feedback across the competencies.

Preparedness and training of genetic counselors practicing in inpatient settings.

As rapid genomic testing technology increasingly allows for real-time answers that could alter management for acutely ill patients, opportunities for genetic counselors to work in inpatient settings will increase. However, genetic counselors' preparedness and the training provided by graduate programs to work in inpatient settings are unknown. We conducted semi-structured interviews with 13 genetic counselors who provided services in varied inpatient settings to assess genetic counselors' readiness for inpatient positions. We also surveyed members of the Association of Genetic Counseling Program Directors (AGCPD) about inpatient training practices of genetic counseling graduate programs. Genetic counselors were recruited through the National Society of Genetic Counselors (NSGC) Inpatient Special Interest Group listserv and graduate program faculty were recruited through the AGCPD listserv. Some challenges reported by genetic counselors in inpatient settings included working in a fast-paced hospital environment which necessitated focused interactions with patients; collaborating with diverse providers who may not understand the role of genetic counselors; and navigating grief experiences of families and of themselves as a provider. Although genetic counselors felt that many of their skills developed in graduate school were transferrable to the inpatient setting, those who had minimal or no inpatient exposure in graduate school often described feeling unprepared for working in the inpatient setting. The majority of AGCPD respondents (23/28) indicated their program provided some type of exposure to the inpatient setting for students, the most common (22/23) being an inpatient clinical rotation, which suggests many graduate programs are already recognizing the importance of providing inpatient training. Our findings indicate that while many skills are transferrable to inpatient positions, genetic counselors face unique challenges in inpatient settings. Our results suggest that graduate exposure to the inpatient setting and professional support of inpatient genetic counselors are beneficial to support genetic counselors' preparedness to take on inpatient positions.